New Study: New Medical Advances Often Not Better, and Sometimes Worse

A study published in the August issue of Mayo Clinic Proceedings reviewed each issue of The New England Journal of Medicine from 2001 through 2010 and found 363 studies examining an established clinical practice. In 146 of them, the currently used drug or procedure was found to be no better, or even worse, than the one previously used. More than 40 percent of established practices studied were found to be ineffective or harmful, 38 percent beneficial, and the remaining 22 percent unknown.

In some instances, doctors routinely refused to give beneficial therapies despite a lack of evidence that they were harmful. Vaccines were unnecessarily withheld from multiple sclerosis patients in the belief that they increased flare-ups; women with lupus were denied oral contraceptives for fear they increased the severity of the disease; and epidural anesthesia was delayed during childbirth on the theory it increased the rate of Caesarean sections. Yet good studies showed that none of these fears was justified.

This evidence has implications for designing employer-sponsored health benefits. Value-based insurance design techniques could be applied to these types of procedures or therapies to discourage their use. Employers should be looking for these types of studies and gain experience in understanding clinical evidence.